Organization
STANLEY LONG DBA HARBOR LIGHTS PROFESSIONAL CHEMICAL DEPENDENCY SERVIC
Active
Organization
STANLEY LONG DBA HARBOR LIGHTS PROFESSIONAL CHEMICAL DEPENDENCY SERVIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STANLEY E LONG (OWNER)
(315) 963-0777
Entity
Organization
Contact information
Practice address
3358 MAIN ST, MEXICO, NY 13114
(315) 963-0777
(345) 963-0611
Mailing address
PO BOX 716, 3358 MAIN ST, MEXICO, NY 13114
(315) 963-0777
(345) 963-0611
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
080211024
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01463294
—
NY
Enumeration date
08/13/2006
Last updated
07/17/2008
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